Is there a duty not to reproduce

6 Is there a duty not to reproduce? Jean McHale Faculty of Law, University of Leicester, Leicester, UK Much of the language used in the debates concerning reproduction surrounds the concepts of rights and of choice: the woman’s right to reproduce; her right to choose; her right to marry and found a family Yet there is another rhetoric, one which has arisen again in recent years, that of responsible parenting, controlled choice The argument has been advanced that individuals are not entitled to reproduce in all situations In fact, that there may rather be certain situations in which they should not reproduce, and even that they may be required not to reproduce It is an uncomfortable language for many in that it harks back to the eugenics debates This paper explores the extent to which persons can ever be regarded as being under a duty not to reproduce and whether such a duty can be legally enforced First, when might such a ‘duty’ arise? Secondly, what considerations would militate against the recognition of such a duty? Thirdly, if such a duty were recognized, then how could it actually be enforced in law? As we shall see in a moment, these are very uncomfortable questions, but new technological developments suggest that increasingly they will have to be addressed New reproductive technologies provide a means of controlling access to reproductive services The clinicians act as gatekeepers in the selection of those who will have access to services In such a situation individuals may be limited in the reproductive choices they make already through state-imposed criteria In the UK, for example, in the context of the Human Fertilisation and Embryology Authority (HFEA) Revised Code of Practice (1998), which provides that: Para 3.17 Where people seek licensed treatment, centres should bear in mind the following factors: (a) their commitment to having and bringing up a child or children; (b) their ability to provide a stable and supportive environment for any child produced as a result of treatment; (c) their medical histories and the medical histories of their families; (d) their health and consequent future ability to look after or provide for a child’s needs; (e) their ages and likely future ability to look after or provide for a child’s needs; (f) their ability to meet the needs of any child or children who may be born as a result of treatment, including the implications of any possible multiple births; 101 102 J McHale (g) any risk of harm to the child or children who may be born, including the risk of inherited disorders or transmissible diseases, problems during pregnancy and of neglect or abuse; and (h) the eVect of a new baby or babies upon any existing child of the family In many respects, Codes of Practice such as that of the HFEA itself and guidelines issued by individual infertility clinics can be regarded as rationing tools in relation to National Health Service (NHS) resources They reXect also the background to treatment services provided under the legislation, which may take several years and ultimately still be unsuccessful It is also a controlled reproductive situation Conception outside the walls of the infertility clinic in the UK is not presently subject to such limitations Using such criteria in a general regulation of potential parents in this manner must surely be ludicrous in practice? None the less, with the technological developments such as screening during pregnancy that we have today, far more information is now available as to the health/viability of the fetus It is inevitably the case that the volume of such information will increase in the future But is it and can it be rightly said that prospective parents are under a duty not to reproduce? The ‘harms’ of reproduction Why talk of a duty not to reproduce? An obvious explanation is that such a duty should be imposed in a situation in which, were reproduction to take place, the resultant child would suVer some form of demonstrable harm after birth, and that such a ‘harm’ should be avoided What, though, we mean in this type of situation by a ‘harm’? One possibility is that the ‘harm’ here is that the child will have some form of physical or mental disorder The direct ‘harm’ in the form of a disability which falls upon the child may also be accompanied by further harms, for example, the parents may be aVected by the birth of the child The couple may not be able to cope with the strain of a severely handicapped child, and relationship breakdown may be the result Take the example of a couple who discover that they are at a very high risk of passing on a degenerative incurable disorder but who want to go ahead and try to conceive a child They may have the option of the use of preimplantation genetic screening, enabling them to select a healthy embryo for implantation This option is likely to be increasingly available in the future, as evidenced in the report on prenatal genetic testing of the Advisory Committee on Genetic Testing (2000) But the couple may object to this – for example, they may have ethical/ religious objections to the destruction of the embryo or they may want to simply take the risk of going ahead in the hope that in their particular case Is there a duty not to reproduce? this risk does not materialize Should they be told that they are wrong both morally and legally to reproduce without having screening? What of a situation in which they are aware of the risk that ‘harm’ may arise, but they argue that the disorder is a late-onset disorder, as a consequence not manifesting itself for many years Again, should they be held to be under a duty not to reproduce? Laura Purdy has strongly argued that it is wrong to reproduce when we know that there is a high risk of transmitting a genetic disease/defect She argues that persons who develop a condition such as Huntington’s disease are unlikely to have what she terms ‘minimally satisfying lives’ As a result, if someone is at risk of passing on the condition, they should not have genetically related children She admits that there are diYculties in attempting to deWne a ‘minimally satisfying life’: Conceptions of a minimally satisfying life vary tremendously among societies and within them De rigueur in some circles are private music lessons and trips to Europe, whereas in others providing eight years of schooling is a major accomplishment But there is no need to consider this complication at length here because we are concerned only with health as a prerequisite for a minimally satisfying life (Purdy, 1996: p 43.) A more limited claim may be that parents should try to secure something like normal health for their children While this may be regarded as an unsatisfactory criterion in that in some cultures debilitating conditions may be the norm, Purdy suggests that this objection can be circumvented by saying that parents ought to try to provide for their children health that is normal for that culture, even though it may be inadequate if judged by some outside standard She states that such a position would still justify eVorts to avoid the birth of children at risk for Huntington’s disease and other serious genetic diseases in all societies (Purdy, 1996: p 46) (See also chapters 13, 19, and 20.) The ‘costs’ of reproduction Another reason why some may seek to impose a duty not to reproduce is that of the resultant ‘costs’ which may result from that reproduction If the couple at risk of bearing a severely handicapped child make the decision to go ahead, then who precisely will bear the cost of care and of medical treatment if the risks attendant upon handicap materialize? The ‘welfare’ mother may decide to go ahead and have a child, but the consequent costs of bringing the child into the world are likely to fall upon the State in such a situation – housing, medical treatment and the fact that the woman may be unable to enter the workforce, at least for some time, due to child-care commitments There has 103 104 J McHale been considerable criticism of such women by governments in the UK, both past and present; in the US, this group has been subject to the targeting of the use of the injectable contraceptive Norplant (Robertson, 1994) Does harm/cost = duty not to reproduce? While some ‘harms’ and some ‘costs’ may be identiWed, does this lead us inexorably to the conclusion that persons should be held to be under a duty not to reproduce? Some may think that conception and birth where there is a risk of those harms/costs arising may be undesirable, but does this ever really equate with imposing a duty not to reproduce, and in particular, backing that duty up through some recognition of legal liability? Robertson (1994) has argued that many of these harms/costs not legitimate limiting reproductive choices First, he suggests that few of those conditions would make the life of a child so horrible that its interests would have been better served had that child never been born Secondly, Robertson argues that because a woman’s reproductive interest is generally very strong, there would need to be compelling criteria to override it, and factors such as saving money would not generally be adequate He takes as examples whether there is a case for compulsory contraception (e.g Norplant implants) to prevent the birth of oVspring with congenital disease or persons who are HIV-positive Robertson says that both groups have substantial interests in reproduction The risk of a handicapped child will ordinarily be one in four Preventing the birth of a handicapped child would also prevent the greater likelihood that the oVspring would not have the disease in question Avoiding the birth of a handicapped child may also require pre-natal testing and abortion to which the parents are opposed Similarly women with HIV may still Wnd procreation immensely meaningful, both because it is a prime source of meaning and validation in their social-cultural context and because it meets their need for continuity after the death looming over them (Robertson, 1994: p 84.) Others, such as Purdy, are less convinced by arguments derived from procreative liberty She suggests that there are other ways in which reproductive desires may be satisWed, including adoption and the use of new reproductive technologies She comments that other arguments for having children, such as wanting the genetic line to be continued, are not particularly rational when it brings a sinister legacy of illness and death She also states that while a desire to bear children who physically resemble oneself is understandable although basically narcissistic, its fulWlment cannot be guaranteed even by normal reproduction Children also not necessarily either prove adulthood or cement marriages Having children on economic grounds as the cushion for old age may not, she argues, provide the expected economic Is there a duty not to reproduce? beneWt if they are ill; indeed, ‘expected economic beneWt is, in many cases, a morally questionable reason for having children’ (Purdy, 1996: p 48) A qualified reproductive right? A ‘duty’ not to reproduce may be seen as being in conXict with other recognized ‘rights’ It could be argued, however, that some of those persons whose opportunity to conceive naturally was, prima facie, limited by a duty not to reproduce, could still conceive through the use of artiWcial reproductive technologies Consider the couple, discussed above, who not want to avail themselves of the new screening technologies One alternative is to say to such a couple, ‘You will be penalized if you reproduce naturally and the ‘‘harm’’ in the form of the disability materializes However, you have the option of pre-implantation genetic diagnosis, and this oVers you an alternative; therefore we are not limiting your reproductive choices, your procreative liberty, to any great extent at all Take the screening which is oVered and set your mind at rest.’ But the initial attractions of such an approach pall considerably on further consideration Before we go down this road we need to address serious and fundamental questions, not simply about an individual’s choice, but also about society’s attitude to the disabled members of our community As the NuYeld Council on Bioethics (1995: p 77, para 8.11) noted, [i]t has been argued that the availability of prenatal screening and diagnosis, together with the termination of seriously aVected pregnancies, both reXect and reinforce the negative attitudes of our society towards those with disabilities Indeed medical genetics may add a new dimension if genetic disorder came to be seen as a matter of choice rather than fate There is also the prospect of the ‘slippery slope’ to eugenics looming into view (Glover, 1998) Furthermore, the recognition of a duty not to reproduce may be regarded as unacceptable because it may mean that a person will in eVect be virtually forced to discover their genetic status should they want to reproduce This may itself have other consequences with regards to the use of that genetic information – for example, with regards to insurance and employment prospects in years to come It may also infringe an individual’s ‘right not to know’ (Chadwick et al., 1997) It is worth noting that the Council of Europe (1996), in the Convention for the Protection of Human Rights and Dignity of the Human Being with Regard to the Application of Biology and Medicine, provides that: Everyone is entitled to know any information collected about his or her health However, the wishes of individuals not to be so informed shall be observed 105 106 J McHale Enforcing a duty not to reproduce – the role of the law? Just for argument’s sake, however, consider what would happen if the objections stated above could be satisfactorily overcome Say that there are certain, perhaps very limited, situations in which individuals may be wrong in seeking to reproduce – so wrong that they should actually be held to be under a duty In the context of a discussion of the use of Norplant for compulsory contraception, even Robertson (1994: p 86) goes on to say that his conclusions may diVer in certain situations: If they [the women] lack capacity or interest in rearing, will institutionalise the child at birth, or face a short life span due to their own illness, required contraception would not violate as signiWcant a reproductive interest as if they intended to rear for long periods If the bodily intrusion associated with compulsory contraception is relatively minor, it may be that compelled contraception in rare cases could be justiWed, though such policies would be highly controversial But this, of course, brings us on to another important issue – namely, to what extent is recognition of such a duty at all practical in law? Some would argue that the a moral duty may be recognizable, but as Robertson has noted, that ‘does not mean that those duties should have legal standing’ (Robertson, 1994: p 177) The Wrst point is whether such a duty would be legally sustainable To hold a woman or a couple liable for their decision to have a child, despite what are substantial warnings regarding the risks of such a course of action, might also constitute a breach of the European Convention on Human Rights – for example, of Article 12, the right to marry and found a family There are fundamental questions regarding the privacy of the individual in relation to their home and family life under Article which would arise in such a situation It should also be noted that the Council of Europe Convention on Human Rights and Biomedicine provides in Article 11 that ‘Any form of non-discrimination against a person on grounds of his or her genetic heritage is prohibited’ We need of course to bear this in mind, particularly in view of the fact that those provisions of the European Convention of Human Rights are now justiciable in the English courts since the Human Rights Act 1988 came into force in October 2000 In fact it is likely that there will be challenges brought in the future by those who have been refused access to IVF treatment under just these provisions in the English courts Secondly, would this be a duty involving state sanctions, enforceable, for example, through the criminal law or will it be limited to civil liability, perhaps in the form of an action brought by the child consequent upon birth? Take Wrst the State-imposed ‘duty’ How you inform people that they are under such a legal duty, and that if they reproduce without Wnding out their genetic status, there may be legal consequences? They will need to know that Is there a duty not to reproduce? the law has changed in this area Should there be a nationwide television campaign? Do we have to put up notices in railway stations, general medical practitioners’ surgeries and night clubs warning people that if they conceive unwittingly, some form of legal liability may result? Secondly, how should such a duty be practically enforced in the courts without bringing the whole concept into disrepute? The Wrst possibility is that I might be held liable in criminal law in such a situation But on what basis? Could there be a special oVence of intentionally conceiving, or would this extend to reckless/negligent conception? Would the sanctions be imposed to avert the harm prior to conception itself occurring? Thus in the case of the ‘welfare mother’ we have already the examples in the US of the use of compulsory contraception – but then presumably the only way in which this could be achieved would be through compulsory testing for the whole population Would the eVect of this be that people would have to have regular tests throughout their lives? There are very few certainties in the world In the case of genetic diseases we are talking about probabilities I may pass on a genetic disease, but also I may not The probability level obviously diVers with regard to the disease in question Do I then have to simply take the risk, knowing that I may be branded a criminal? It may be possible for certain medical conditions to be cured or at the very least alleviated thanks to developments in medical technology Could, and indeed should, individuals be allowed to ‘wait and see’? After all, with the pace of technological developments such as gene therapy, the serious degenerative late-onset disorder may be curable by the time that infant reaches adulthood When then would the prosecution take place – 25 years after the event perhaps? If I am prosecuted, just what sanctions will be imposed on me? A prison sentence? I may be told that I could have avoided any legal liability, because I had the opportunity to abort, but what if I am violently opposed to abortion? Or it is the case that I would be told if this condition emerged? It is also the case that the practical diYculties of recognizing such a duty may also collide with another set of legal principles, namely, membership of the European Union The imposition of a duty not to reproduce would surely oVend against the notion of free movement principles in the European Union (Hervey, 1998) The ability to travel to another nation to bear a child – something which older mothers who have been denied NHS infertility treatment have done, and something which Diane Blood did to enable her to be inseminated with her deceased husband’s sperm – would undoubtedly come into play in such a situation (R v Human Fertilisation and Embryology Authority ex parte Blood, 1997) Cases such as that of Blood send out a powerful message – European regulation is changing the face of health care today, and single jurisdiction regulation may indeed be inadequate in health care law 107 108 J McHale Repaying the state An alternative is to say to the individual/couple: ‘Yes, you may reproduce in a ‘‘risky’’ situation, but if the ‘‘harm’’ does arise and, as a consequence, the state incurs costs, then you will be liable to pay that cost’ This solution, however, can be seen as undesirable, in that at the very least it is discriminatory between those with Wnancial resources and those without Those with such resources may decide to go ahead and know that whatever happens, they have the resources to care for the children Disabled children may thus be born, but only to the wealthier members of society Such a discriminatory provision is not only divisive but again would almost certainly be the subject of challenge on human rights grounds Civil law liability Another option would be to hold the parent/parents accountable in civil law But by whom? Firstly, there could be a state action in relation to the recovery of costs incidental to NHS treatment for the care of a disabled child Secondly, an action could be brought by the child, for example, claiming that the parents’ actions resulted in their birth in a disadvantaged or disabled condition There are a number of diYculties in such a course of action First, would the parents be worth suing? Are they insured against legal costs? At present the potential for such actions in civil law is limited The Congenital Disabilities Civil Liability Act 1976 provides that an action may be brought by a child born with a disability as a result of an occurrence which aVects either of its parents in their ability to have a normal healthy child, or an occurrence which aVects the mother during pregnancy and either mother and child during birth The child’s claim under this statute, however, is limited because it derives from breaches of duty owed to the parent of the child While there is the possibility that fathers may be sued under the Congenital Disabilities Civil Liability Act 1976, the mother is excluded from liability with the exception of the situation where she has been involved in a road traYc accident Limiting actions under the 1976 Act could be seen in terms of limited notions of paternal misconduct However, as Brazier (1998: p 268) notes, today medical science makes everything so much more complex: Some of the practical grounds for exempting mothers from liability for parental liability for prenatal injury need to re-examined in relation to fathers too Questions as to what constitutes reasonable parental conduct, what good suing a parent does the disabled child, may apply with equal force to both parent Alternatively a child may seek to bring an action at common law, claiming that they should have never been born This is known as a ‘wrongful life’ Is there a duty not to reproduce? action The existence of such an action in English law was rejected in McKay v Essex AHA (1982) Mary McKay was born in 1975 She had been infected, whilst in the womb, with rubella and as a consequence was partially blind and deaf The allegation was made that one doctor had acted negligently in failing to treat rubella infection Also it was claimed that another doctor had either negligently mislaid a blood sample or had failed to interpret the results of such tests The real issue in the case was, however, the claim by Mary McKay that the doctor owed her a duty of care when she was in utero, which involved advising her mother as to the desirability of having an abortion, which advice the mother said she would have accepted In the Court of Appeal the claim was rejected on a number of grounds First, if the duty of care to the fetus involved imposing a duty on the doctor – albeit indirectly – to prevent the child’s birth, the child would have a cause of action against her mother if she refused to have an abortion The fact that a doctor can lawfully terminate life did not mean that the child had a right to die To recognize such a right would be contrary to public policy Secondly, the Law Commission in their Report on Injuries to Unborn Children (1974), which had rejected the wrongful life claim, had been of the view that such a claim would impose intolerable burdens on the medical profession, because of subconscious pressure to advise abortion in doubtful cases through fear of action for damages Interestingly one of the members of the Court of Appeal, GriYth LJ, did not see this as a tenable ground He was of the view that provided that the defendants gave a balanced explanation of risks involved in alleged pregnancy, including risk of injury to the fetus, the doctor could not be expected to more But that may only exonerate the doctor; what of the mother? Thirdly, the Court of Appeal was unhappy regarding the evaluation of damages How could a court attempt to evaluate non-existence – to compare non-existence and the value of existence in a disabled state? The only duty of care which can be recognized was one that could be assessed in monetary terms Stephenson LJ, for example, noted the rejection of a wrongful life claim in the 1967 US case of Gleitman v Cosgrave, where the court had said that in assessing damages the problem was the question of whether X would have been better oV not being born at all, ‘A man who knows nothing of death or nothingness cannot possibly know whether that is so’ (227 A 2d 689 at 711) Finally, the Court of Appeal held that section 4(5) of the Congenital Disabilities (Civil Liability) Act 1976 excluded liability in wrongful life claims, a point on which all the members of the Court of Appeal in this case agreed Section 4(5) of the 1975 Act provides that the Act applies to all births after its passing, and in respect of any such birth, it replaces any law in force before its passage whereby a person could be held liable to a child in respect of disabilities with which it might be born The rejection of wrongful life actions is itself a controversial area, one 109 110 J McHale which goes considerably beyond the scope of this chapter, and much has been written on the issue (Harris, 1998) The policy arguments against their acceptance, as outlined in relation to the judgments of the Court of Appeal in this case, have been echoed by academic commentators (Lee, 1989; Fortin, 1987) An alternative approach which has been suggested is to change the terminology used For example, Mason and McCall Smith have suggested that ‘we favour abandoning the principle of ‘‘wrongful life’’ in favour of diminished life; we can then look not at a comparison, whether it be between the neonate’s current existence and non-existence or with normality, but rather at the actual suVering that has been caused’ (Mason and McCall Smith, 1999: p 165) They comment further that, ‘This carries the practical advantage that the courts can understand and accommodate this form of damage, which allows for a distinction to be made between the serious and slight defect’ (Mason and McCall Smith, 1999: p 165–6), although presumably the diYculty with this approach is to ascertain what precisely constitutes the actual suVering caused At the present time, however, recognition of such an action appears unlikely in English civil law Even if such an action were recognized in principle, establishing it could prove diYcult What of fathers? Should civil law liability apply only where the individual is in an established relationship? What of the woman who becomes accidentally pregnant? Does this mean that the concept of parental liability extends beyond the scope of the Child Support Agency to civil law liability? What if genetic tests are undertaken which, while they appear clear, are actually faulty? Presumably in this situation the couple would not be liable, but here an action may then be brought against the clinician, precisely the type of action rejected in McKay What happens if it is some time since the couple was tested, but they conceive and then discover that the fetus is handicapped? Are they held to be not liable in law as long as they have taken ‘reasonable steps’ to discover their risk of transmitting disease/defect? The diYculties that arise in the context of the competent adult are magniWed still further when we consider mentally incompetent persons and the teenage pregnancy Do we penalize teenagers whether or not they know of the risk which they may be under with regards to conception? What about the overlap with abortion once a woman discovers, during pregnancy, that she is carrying a handicapped fetus? The consequences of a duty not to reproduce are such that it is unlikely that the courts would be willing to impose such a duty, at present, upon the parents None the less the possibility does remain, given the enhanced availability of genetic knowledge, that this situation may change Attitudes regarding individuals taking responsibility for their own health and that of others may indeed have a bearing here Is there a duty not to reproduce? Concluding thoughts Enforcing a duty not to reproduce may seem unrealistic and even perhaps ludicrous at present, but as technology develops and the increasing emphasis in our society on the birth of the ‘perfect child’ continues, this is a matter that will undoubtedly arise in the future Comparisons can be drawn with the way in which pregnancy over the last decade has become policed by those who advocate responsible motherhood This has on occasions, as we have seen in relation to enforced Caesarean sections, led to an area of private life being increasingly subject to regulation While the English courts have now afWrmed, for example, the right of the pregnant woman to refuse a Caesarean section, this debate is still ongoing (Re MB, 1997; St George’s NHS Trust v S, 1998; Bailey Harris, 1998; Wells, 1998) (See Chapter 17.) Again, while behaviour during pregnancy is not explicitly regulated in English law (Re F, 1988) in the way in which it has been in many US states, leading to criminal sanctions being placed upon women whose behaviour may place the fetus at risk of harm, the pressure placed upon pregnant women to behave ‘responsibly’ has deWnitely heightened (Roth, 1999) (See Chapter 7.) As more widespread genetic information becomes available, it is likely to render us increasingly critical of those who make what we regard as being the ‘wrong’ decision in relation to reproduction What that wrong decision is remains of course to be seen Choosing to avert a handicap may be one such decision, but acting on preferences about height/eye colour and indeed intelligence may be others Any restrictions are likely to meet challenges on human rights grounds and the Human Rights Act 1998 would undoubtedly be used in this context The rights of the fetus, and of the woman, are likely to lead to heated debates None the less, while these are uncomfortable arguments, and while there are considerable problems in the legal enforcement of such duties, there is no doubt that the changing face of genetics will force us to address them What is important is that such arguments should be addressed in advance by clinicians, lawyers and philosophers alike, rather than allowing ourselves to be precipitated into dealing with them in the courtroom References Advisory Committee on Genetic Testing (2000) Prenatal Genetic Testing London: Department of Health Bailey Harris, R (1998) Pregnancy, autonomy and refusal of medical treatment Law Quarterly Review, 144: 550 Brazier, M (1998) Parental responsibilities, foetal welfare and children’s health.’ In Family Law into the Millennium, ed C Bridge, pp 266–293 London: Butterworths 111 112 J McHale Chadwick, R., Shickle, D., and Levitt, M (eds) (1997) The Right to Know and the Right Not to Know Aldershot: Ashgate Council of Europe (1996) Convention for the Protection of Human Rights and Dignity of the Human Being with Regard to the Application of Biology and Medicine: Bioethics Conventions Strasburg: Dir/Jur(96)2 Fortin, J (1987) Is the wrongful life action really dead?’ Journal of Social Welfare Law, p 306 Gleitman v Cosgrave (1967) 227 A 2d 689 Glover, J (1998) Eugenics: some lessons from the Nazi experience In The Future of Human Reproduction, ed J Harris and S Holm, p 55–65 Oxford: Oxford University Press Harris, J (1998) Clones, Genes and Immortality Oxford: Oxford University Press Hervey, T (1998) European Social Law and Policy London: Longmans Human Fertilisation and Embryology Authority (1998) Code of Practice, 4th edn London: Stationery OYce Lee, R (1989) To be or not to be, is that the question: the claim of wrongful life In Birthrights, ed R Lee and R Morgan London: Routledge McKay v Essex AHA [1982] All ER 771 Mason, J.K., and McCall Smith, R.A (1999) Law and Medical Ethics London: Butterworths, 5th edn NuYeld Council on Bioethics (1995) Genetic Screening London: NuYeld Council on Bioethics Purdy, L (1996) Reproducing Persons: Issues in Feminist Bioethics Ithaca, NY: Cornell University Press R v Human Fertilisation and Embryology Authority ex parte Blood [1997] All ER 687 Re F (in utero) [1988] All ER 193 Re MB [1997] Med LR 217 Robertson, J (1994) Children of Choice; Freedom and the New Reproductive Technologies Princeton; Princeton University Press Roth, R (1999) Making Women Pay: The Hidden Costs of Fetal Rights Ithaca, NY: Cornell University Press St Georges Healthcare NHS Trust v S [1998] All ER 673 Wells, C (1998) On the outside looking in: perspectives on enforced caesareans In Feminist Perspectives on Health Care Law, ed S Sheldon and M Thomson London: Cavendish  ... of a situation in which they are aware of the risk that ‘harm’ may arise, but they argue that the disorder is a late-onset disorder, as a consequence not manifesting itself for many years Again,... their particular case Is there a duty not to reproduce? this risk does not materialize Should they be told that they are wrong both morally and legally to reproduce without having screening? What... genetic status, there may be legal consequences? They will need to know that Is there a duty not to reproduce? the law has changed in this area Should there be a nationwide television campaign? Do